In the course of developing new drugs, manufacturers must collect significant pre-clinical and clinical data as part of the clinical trials process to prove the safety and effectiveness of new compounds for specific clinical indications. Recent trends include the gathering of medical images to provide additional supporting evidence, or to provide an additional safety measure during the clinical trials process.
Typically a manufacturer or Sponsor of a clinical trial will establish a contract with one or more imaging centers to perform the image acquisition on the patients that are part of the trial. In addition, the Sponsor may contract with one or more Clinical Research Organizations (CROs) to gather and evaluate the images acquired by the imaging centers, and to compose statements that prove or disprove findings based on the image data acquired and a clinical protocol. The current process is shown in FIG. 1. As can be seen, at step 10 the Sponsor provides a Clinical Protocol to one or more CRO's. (Although the description will proceed by referring to a single CRO, it will be appreciated that there may be more than one CRO involved in a particular trial). The Clinical Protocol is an action plan or guideline that must be followed during the course of the study. Examples of such guidelines include a description of what will be studied and how, criteria for patients who may enter the study, and specifically what medical images will be acquired for each entered patient.
The Sponsor establishes a business contract with a CRO to perform the clinical protocol. This agreement identifies the clinical protocol to be performed as well as the particular Imaging Centers that will participate in the study. In turn, the CRO creates a clinical imaging protocol for the Imaging Centers to use. The CRO performs initial site readiness and qualification testing 30 at the Imaging Centers, and also establishes the imaging protocols (magnetic resonance imaging (MRI) or computed tomography (CT) parameters, for example) at the Imaging Centers.
As part of the above process, the Sponsor may establish a business contract with the one or more of Imaging Centers who will provide image acquisition services during the trial. The agreement typically specifies how many patients are needed in the study and how many data sets the Imaging Center must deliver. It also stipulates when the images must be sent to the CRO. Before sending the images, the Imaging Center must de-identify the data and add study identifiers before sending the data. As part of the image acquisition services, at 30, the Imaging Centers may install necessary hardware and software to support the imaging protocols. The Imaging Centers may select one or more patients for scanning 40. Once the patients are scanned 50, the Imaging Center may remove any patient-personal identification data from the images 60. Study identifiers are then added to the images 70. At 80, the images may be sent to the CRO, which receives the de-identified images at 90, analyzes them in accordance with the Clinical Protocol at 100, then collects the analyses together along with other information to form the final report at 110. The report is then sent to the Sponsor at 120. As noted, this process can occur using multiple CRO's and multiple Imaging Centers.
Typically the Imaging Center are required to send the images to the CRO within two weeks of having acquired the image. In the ideal case, the Imaging Center ships the imaging study immediately (within 24 hours) to the CRO for evaluation. Once a sufficient number of images have been received, the CRO then analyzes the images and draws conclusions based on the study protocol. These conclusions are then communicated to the Sponsor as part of their final report.
In practice, however, the Imaging Centers commonly make errors in the image data acquisition. This is primarily due to the fact that patients who meet the study criteria may be “imaged” infrequently, and the imaging technologist (MR or CT) may not remember or may not perform the study in the exact manner prescribed by the clinical imaging protocol. In addition, since there is no “on-line” method of transmitting the acquired image data to the CRO, the Imaging Center must store the image data on one or more pieces of removable media (CD or DVD) and then ship the media to the CRO via conventional ground or air transportation. These additional steps take invaluable time away from the technologist thereby reducing his/her productivity. They also introduce latency in the process because of the extra effort required to ship the data to the CRO. These sources of error cause the Sponsor to incur unnecessary expenses.
FIG. 2 is an illustration of the number of studies at each step in an exemplary conventional process. As can be seen, for 120 images sent to the CRO by the Imaging Center, only 100 are accepted, 15 are rejected, and 5 partially qualify. Thus, of the original 120 images, only 105 are ultimately used by the CRO in generating the final report to the Sponsor.
FIG. 3 illustrates the data flow in a typical clinical trial, in which multiple imaging centers (Imaging Ctrs. A-D) provide image data to a CRO for analysis, compilation and transmittal of a final report to the Sponsor. At step 200, each imaging center (A-D) is typically contracted by the Sponsor for a fixed dollar amount to provide a fixed number of “studies” (i.e., patient images). The number contracted for is usually somewhat larger than what is required for the actual study to take into account the common existence of “unusable” studies (i.e., those that fail to comply with the study protocol for any of a variety of reasons). Once the CRO receives the studies at step 210 (Data Acq. Complete”), it analyzes the studies to verify their compliance to the study protocol.
As noted, it is often the case that a number of studies do not comply (in FIG. 3, non-compliant studies out of the total group of studies 220 received by the CRO are marked with a hash box). These studies must be removed from the data pool and are not used in formulating the report (shown below the timeline). Some studies may also partially qualify (marked in dark gray in the figure) and will be forwarded to the Sponsor. For non-compliant studies, or for partially qualifying studies, it is not practical to re-scan the patient because the patient will have long since left the Imaging Center (since imaging may occur days or weeks before the images are reviewed by the CRO). Furthermore, since the CRO determines whether a study qualifies to be included, and the Imaging Center may not receive any feedback as to why the study was rejected, the Imaging Center has no means of rapidly improving their process in order to achieve a higher success rate. If the quality determination was done at the Imaging Center, it would have the opportunity to do a root cause analysis and implement process improvements that would increase their success. The Sponsor considers the report(s) received from the CRO at 230 to make final judgments about the experiment. Currently images are not available to the Sponsor to corroborate the findings. The timeline ends when the final study report is produced by the Sponsor.
The existing practice is unnecessarily slow and inefficient, and the mechanics of shipping the data on removable media is slow and cumbersome. In addition to the delay, there are substantial costs involved in packaging and postage for the data media (CDs, DVDs)). Furthermore, the infrequency of qualified patients is a root cause for many errors. The business model of paying for a fixed number of studies, even though much of the data may not be useable, is non-optimal.
Thus, there is a need for a system that will speed the process of obtaining and reviewing medical images acquired as part of a clinical trials program. Such a system should minimize the number of unusable images, thus reducing overall costs borne by the trial Sponsor.